Goal

The goal of this paper is to describe the level of agreement and a harmonized scale of severity applicable to several commonly used delirium instruments: the CAM-S, DRS-R98, MDAS. We do this in the context of a single clinical research study, where a team of trained lay interviewers administered each instrument along with supporting stimulus assessments in the same group of patients.

Note: In writing the paper, use the term “features” instead of “signs/symptoms”.

Summary of Results So Far

IRT Models (dichotomous outcomes) estimated for all three instruments: CAM-S, DRS, MDAS

The instrument item responses were dichotomized into “none” vs “any” symptom.

The model fit to 6 or 7 core items per instrument is good. The core items include Sleep disturbance, Perceptual disturbance, Psychomotor agitation/retardation, Orientation, Attention, and Memory impairment.

Initially the fit to the expanded item sets was unacceptably bad. Then we recoded the sleep disturbance item, combining the “none” and “mild” categories. The model fit was then acceptable.

Item Parameters have been co-calibrated

The MDAS and CAM-S items have been equated to the DRS.

The items used to link the MDAS to the DRS are: Disorientation, Perceptual disturbance, Sleep/wake cycle disturbance, Short term memory impairment, and Delusions.

The items used to link the CAM-S to the DRS are: Disorientation, Perceptual disturbance, Sleep/wake cycle disturbance, Psychomotor agitation, Psychomotor retardation, and Attention.

Created item response theory plots for the dichotomous outcome models

Created plots for: Test Information function, Item characteristic curves, Test characteristic curves, and density plots of estimated latent scores.

Estimated thresholds for polytomous outcomes for all three instruments: CAM-S, DRS, MDAS

Used the equated item parameters from the previous step to estimate the thresholds for the polytomous outcomes.

Note: Some thresholds are missing for some items since the highest categories weren’t observed.

Created item response theory plots for the polytomous outcome models

Created plots for: Test Information function, Item characteristic curves, Test characteristic curves, and density plots of estimated latent scores.

Created the proposed tables/figures for the manuscript

The tables are the typical Table 1 and a table of model fit statistics. The figures include a plot showing the item thresholds, a scatter plot of the scores for the three instruments, a test information curve, and a test characteristic curve that can create a crosswalk between instruments.

Created nomograms for the appendix

The figures currently aren’t good. I’m open to suggestions to improve them.

Examined the difference in information provided using polytomous versus dichotomous outcomes

We were interested in whether we could use the items as dichotomous outcomes in the new instrument since it would make training to use the instrument easier. However, the higher category outcomes provide a lot of information at higher “Delirium Intensity” levels. We felt this would be needed for a severity instrument.

Report

Data Processing

Read Data

The data comes from /BASIL/POSTED/DATA/DERIVED/clean/current/. On 9-17-2017, the data was copied to the folder /BASIL/Projects/DeliriumHarmonization/POSTED/DATA/DERIVED/clean/current/ to make the results reproducible.

The file has 352 subjects and 1190 interviews.

This analysis will only use baseline hospital visits and daily hospital visits. Interviews that are not complete are dropped. Interviews that are missing the CAM-S vds, the DRS vds, or the MDAS vds are dropped. There are three subjects that de-enrolled from the study and are dropped from the analysis. [11-9-2017 decision: Do not exclude these three subjecs.] After applying these filters there are 352 subjects and 1178 interviews remaining in the datafile.

Data recode

The items that were coded as Don’t Know, Refused, Uncertain were set to missing, and the response options were reordered such that no symptoms were 0 and any symptoms were positive values.

The DRS, MDAS, CAM-S items are dichotomized to None vs Any symptom.

It is always possible once the item parameters are calibrated in the dichotomous setting to go back to the polytomous response setting. However, there should be at least 5% in the response categories and that is not always the case. So, we may end up in a situation where some items are dichotomous and others are polytomous. This makes the interpretation more difficult.

Item reference table

This table is a reference for the following tables to link item numbers to item content

DRS

Item Content
rdrs01 Sleep-wake cycle disturbance
rdrs02 Perceptual disturbances and hallucinations
rdrs03 Delusions
rdrs04 Lability of affect
rdrs05 Language
rdrs06 Thought process abnormalities
rdrs07 Motor agitation
rdrs08 Motor retardation
rdrs09 Orientation
rdrs10 Attention
rdrs11 Short-term memory
rdrs12 Long-term memory
rdrs13 Visuospatial ability

MDAS

Item Content
rmdas01 Reduced level of consciousness (Awareness)
rmdas02 Disorientation
rmdas03 Short-term memory impairment
rmdas04 Impaired digit span
rmdas05 Reduced ability to maintain and shift attention
rmdas06 Disorganized thinking
rmdas07 Perceptual disturbance
rmdas08 Delusions
rmdas09 Decreased or increased psychomotor activity
rmdas10 Sleep-wake cycle disturbance

CAM-S

Item Content
rcamlf1a Acute change
rcamlf2a Inattention
rcamlf3a Disorganized thinking
rcamlf4a Altered level of consciousness
rcamlf5a Disorientation
rcamlf6a Memory impairment
rcamlf7a Perceptual disturbances
rcamlf8a Psychomotor agitation
rcamlf8d Psychomotor retardation
rcamlf9a Sleep-wake cycle disturbance

Descriptive statistics

Summary table for DRS (N=1178)

Original item categories (%)
Item 0 1 2 3 Missing
rdrs04 97.62 1.70 0.59 0.00 0.08
rdrs08 97.62 1.78 0.59 0.00 0.00
rdrs07 97.03 2.29 0.51 0.00 0.17
rdrs03 94.99 2.55 0.68 1.02 0.76
rdrs05 86.93 11.46 1.10 0.34 0.17
rdrs13 86.76 9.76 1.87 0.08 1.53
rdrs06 86.16 8.57 4.67 0.42 0.17
rdrs02 84.13 4.58 3.90 6.62 0.76
rdrs09 75.13 14.43 9.51 0.42 0.51
rdrs11 52.29 25.30 7.56 14.18 0.68
rdrs12 45.50 23.60 11.46 17.74 1.70
rdrs10 43.12 43.04 12.99 0.76 0.08
rdrs01 25.64 67.66 6.03 0.34 0.34

Dichotomized item categories (%)

Item 0 1 Missing
rdrs04 97.62 2.29 0.08
rdrs08 97.62 2.38 0.00
rdrs07 97.03 2.80 0.17
rdrs03 94.99 4.24 0.76
rdrs01 93.29 6.37 0.34
rdrs05 86.93 12.90 0.17
rdrs13 86.76 11.71 1.53
rdrs06 86.16 13.67 0.17
rdrs02 84.13 15.11 0.76
rdrs09 75.13 24.36 0.51
rdrs11 52.29 47.03 0.68
rdrs12 45.50 52.80 1.70
rdrs10 43.12 56.79 0.08

Summary table for MDAS (N=1178)

Original item categories (%)

Item 0 1 2 3 Missing
rmdas08 94.91 3.23 1.10 0.08 0.68
rmdas09 94.91 3.74 1.27 0.00 0.08
rmdas01 94.57 4.16 1.19 0.00 0.08
rmdas06 84.55 10.70 4.16 0.59 0.00
rmdas07 84.21 12.82 2.21 0.08 0.68
rmdas02 76.40 14.18 5.69 3.14 0.59
rmdas05 58.74 29.20 11.12 0.93 0.00
rmdas03 51.19 23.68 18.76 5.69 0.68
rmdas04 29.20 57.22 12.56 0.59 0.42
rmdas10 25.47 68.85 5.01 0.34 0.34

Dichotomized item categories (%)

Item 0 1 Missing
rmdas08 94.91 4.41 0.68
rmdas09 94.91 5.01 0.08
rmdas01 94.57 5.35 0.08
rmdas10 94.31 5.35 0.34
rmdas06 84.55 15.45 0.00
rmdas07 84.21 15.11 0.68
rmdas02 76.40 23.01 0.59
rmdas05 58.74 41.26 0.00
rmdas03 51.19 48.13 0.68
rmdas04 29.20 70.37 0.42

Summary table for CAM-S (N=1178)

Original item categories (%)

Item 0 1 2 Missing
rcamlf8d 97.45 2.29 0.25 0.00
rcamlf8a 97.28 2.38 0.34 0.00
rcamlf4a 96.43 0.17 3.40 0.00
rcamlf7a 85.82 12.14 1.36 0.68
rcamlf3a 84.47 12.14 3.40 0.00
rcamlf5a 76.40 15.87 7.13 0.59
rcamlf1a 74.19 25.04 0.00 0.76
rcamlf6a 72.58 22.75 3.99 0.68
rcamlf2a 42.02 44.23 13.58 0.17
rcamlf9a 25.04 68.85 5.69 0.42

Dichotomized item categories (%)

Item 0 1 Missing
rcamlf8d 97.45 2.55 0.00
rcamlf8a 97.28 2.72 0.00
rcamlf4a 96.43 3.57 0.00
rcamlf9a 93.89 5.69 0.42
rcamlf7a 85.82 13.50 0.68
rcamlf3a 84.47 15.53 0.00
rcamlf5a 76.40 23.01 0.59
rcamlf1a 74.19 25.04 0.76
rcamlf6a 72.58 26.74 0.68
rcamlf2a 42.02 57.81 0.17
## 
## Running model: cfa-drs-1-1-2pl.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-drs-1-1-2pl.inp" 
## Reading model:  cfa-drs-1-1-2pl.out 
## Reading model:  cfa-drs-1-1-2pl.out 
## 
## Running model: cfa-drs-2-1-2pl.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-drs-2-1-2pl.inp" 
## Reading model:  cfa-drs-2-1-2pl.out
## 
## Running model: cfa-drs-1-1-wlsmv.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-drs-1-1-wlsmv.inp" 
## Reading model:  cfa-drs-1-1-wlsmv.out 
## Reading model:  cfa-drs-1-1-wlsmv.out 
## 
## Running model: cfa-drs-2-1-wlsmv.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-drs-2-1-wlsmv.inp" 
## Reading model:  cfa-drs-2-1-wlsmv.out
## 
## Running model: cfa-mdas-1-1-2pl.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-mdas-1-1-2pl.inp" 
## Reading model:  cfa-mdas-1-1-2pl.out 
## Reading model:  cfa-mdas-1-1-2pl.out 
## 
## Running model: cfa-mdas-2-1-2pl.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-mdas-2-1-2pl.inp" 
## Reading model:  cfa-mdas-2-1-2pl.out
## 
## Running model: cfa-mdas-1-1-wlsmv.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-mdas-1-1-wlsmv.inp" 
## Reading model:  cfa-mdas-1-1-wlsmv.out 
## Reading model:  cfa-mdas-1-1-wlsmv.out 
## 
## Running model: cfa-mdas-2-1-wlsmv.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-mdas-2-1-wlsmv.inp" 
## Reading model:  cfa-mdas-2-1-wlsmv.out
## 
## Running model: cfa-cam-1-1-2pl.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-cam-1-1-2pl.inp" 
## Reading model:  cfa-cam-1-1-2pl.out 
## Reading model:  cfa-cam-1-1-2pl.out 
## 
## Running model: cfa-cam-2-1-2pl.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-cam-2-1-2pl.inp" 
## Reading model:  cfa-cam-2-1-2pl.out
## 
## Running model: cfa-cam-1-1-wlsmv.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-cam-1-1-wlsmv.inp" 
## Reading model:  cfa-cam-1-1-wlsmv.out 
## Reading model:  cfa-cam-1-1-wlsmv.out 
## 
## Running model: cfa-cam-2-1-wlsmv.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-cam-2-1-wlsmv.inp" 
## Reading model:  cfa-cam-2-1-wlsmv.out

Model Fitting (Dichotomous model)

Fit CFA models

We will fit a CFA in the MDAS, DRS, and CAM-S individually then equate them. To ensure that the CFA covers the same dimension for each test, we are fitting the CFA to a core set of items in common across test and then add in the remaining items keeping the core item parameters fixed.

The core set of items are:

Feature DRS MDAS CAM-S
Sleep disturbance drs01 mdas10 camlf9a
Perceptual disturbance drs02 mdas07 camlf7a
Psychomotor agitation/retardation drs07, drs08 mdas09 camlf8a, camlf8d
Orientation drs09 mdas02 camlf5a
Attention drs10 mdas04, mdas05 camlf2a
Memory impairment drs11, drs12 mdas03 camlf6a
Disorganized thinking/thought process abnormalities drs06 mdas06 camlf3a

NOTE: In the original 2PL models, the sleep item did not fit well. To try to improve the fit, we tried changing to a 3PL model. This did not improve the fit. So, next we changed the way we dichotomized sleep. Instead of grouping the categories 0 vs 1, 2, 3, we used 0, 1 vs 2, 3. This helped improve the fit in the DRS and MDAS a lot and in the CAM-S a little.

DRS Confirmatory Factor Analysis

Fit statistics

Model 1

## Reading model:  cfa-drs-1-1-wlsmv.out
N CFI RMSEA
1178 0.98 0.03

Model 2

## Reading model:  cfa-drs-2-1-wlsmv.out
N CFI RMSEA
1178 0.97 0.08

Item Parameters

Model 1

## Reading model:  cfa-drs-1-1-2pl.out
Item Slope Threshold
rdrs06 3.54 4.31
rdrs10 2.66 NA
rdrs09 1.75 1.68
rdrs07 1.63 4.69
rdrs11 1.36 NA
rdrs02 1.20 2.14
rdrs08 1.09 4.26
rdrs01 0.93 3.04

Model 2

## Reading model:  cfa-drs-2-1-2pl.out
Item Slope Threshold
rdrs06 3.54 4.31
rdrs10 2.66 -0.55
rdrs12 2.44 -0.31
rdrs09 1.75 1.68
rdrs07 1.63 4.69
rdrs13 1.61 2.75
rdrs05 1.59 2.67
rdrs03 1.51 4.02
rdrs04 1.49 4.75
rdrs11 1.36 0.13
rdrs02 1.20 2.14
rdrs08 1.09 4.26
rdrs01 0.93 3.04

MDAS Confirmatory Factor Analysis

Fit statistics

Model 1

## Reading model:  cfa-mdas-1-1-wlsmv.out
N CFI RMSEA
1178 0.97 0.04

Model 2

## Reading model:  cfa-mdas-2-1-wlsmv.out
N CFI RMSEA
1178 0.98 0.02

Item Parameters

Model 1

## Reading model:  cfa-mdas-1-1-2pl.out
Item Slope Threshold
rmdas06 3.77 4.23
rmdas05 2.55 0.69
rmdas02 2.12 1.99
rmdas03 1.45 0.08
rmdas09 1.42 NA
rmdas07 1.20 2.14
rmdas04 1.20 -1.12
rmdas10 0.80 NA

Model 2

## Reading model:  cfa-mdas-2-1-2pl.out
Item Slope Threshold
rmdas06 3.77 4.23
rmdas05 2.55 0.69
rmdas01 2.51 4.97
rmdas02 2.12 1.99
rmdas08 1.59 4.06
rmdas03 1.45 0.08
rmdas09 1.42 3.76
rmdas07 1.20 2.14
rmdas04 1.20 -1.12
rmdas10 0.80 3.14

CAM-S Confirmatory Factor Analysis

Fit statistics

Model 1

## Reading model:  cfa-cam-1-1-wlsmv.out
N CFI RMSEA
1178 0.99 0.02

Model 2

## Reading model:  cfa-cam-2-1-wlsmv.out
N CFI RMSEA
1178 0.92 0.09

Item Parameters

Model 1

## Reading model:  cfa-cam-1-1-2pl.out
Item Slope Threshold
rcamlf3a 3.92 4.37
rcamlf2a 2.45 -0.60
rcamlf5a 2.27 2.09
rcamlf6a 1.96 1.59
rcamlf8a 1.65 4.74
rcamlf7a 1.36 2.40
rcamlf8d 1.01 NA
rcamlf9a 0.73 NA

Model 2

## Reading model:  cfa-cam-2-1-2pl.out
Item Slope Threshold
rcamlf3a 3.92 4.37
rcamlf1a 2.61 2.08
rcamlf2a 2.45 -0.60
rcamlf5a 2.27 2.09
rcamlf6a 1.96 1.59
rcamlf4a 1.95 4.79
rcamlf8a 1.65 4.74
rcamlf7a 1.36 2.40
rcamlf8d 1.01 4.11
rcamlf9a 0.73 3.03

Item equating

Using the SNSequate package to equate item parameters.

## Reading model:  cfa-drs-2-1-2pl.out
## Reading model:  cfa-mdas-2-1-2pl.out
## Reading model:  cfa-cam-2-1-2pl.out

DRS item parameters

## Reading model:  cfa-drs-2-1-2pl.out
Item parameters for DRS with dichotomous outcomes
Item A B1
rdrs01 0.93 3.26
rdrs02 1.20 1.78
rdrs03 1.51 2.66
rdrs04 1.49 3.20
rdrs05 1.59 1.68
rdrs06 3.54 1.22
rdrs07 1.63 2.88
rdrs08 1.09 3.91
rdrs09 1.75 0.96
rdrs10 2.66 -0.21
rdrs11 1.36 0.10
rdrs12 2.44 -0.13
rdrs13 1.61 1.71

MDAS item parameters

## Reading model:  cfa-mdas-2-1-2pl.out
Item parameters for MDAS with dichotomous outcomes
Item A B1
rmdas01 2.51 1.98
rmdas02 2.12 0.94
rmdas03 1.45 0.05
rmdas04 1.20 -0.94
rmdas05 2.55 0.27
rmdas06 3.77 1.12
rmdas07 1.20 1.78
rmdas08 1.59 2.55
rmdas09 1.42 2.64
rmdas10 0.80 3.95

CAM-S item parameters

## Reading model:  cfa-cam-2-1-2pl.out
Item parameters for CAM with dichotomous outcomes
Item A B1
rcamlf1a 2.61 0.80
rcamlf2a 2.45 -0.24
rcamlf3a 3.92 1.11
rcamlf4a 1.95 2.46
rcamlf5a 2.27 0.92
rcamlf6a 1.96 0.81
rcamlf7a 1.36 1.76
rcamlf8a 1.65 2.87
rcamlf8d 1.01 4.07
rcamlf9a 0.73 4.17

The items used to link the MDAS to the DRS are: Disorientation, Perceptual disturbance, Sleep/wake cycle disturbance, Short term memory impairment, Delusions, and Thought process abnormality/Disorganized thinking.

The items used to link the CAM-S to the DRS are: Disorientation, Perceptual disturbance, Sleep/wake cycle disturbance, Psychomotor agitation, Psychomotor retardation, Attention, and Thought process abnormality/Disorganized thinking.

## 
## Running model: cfa-mdas-link-1.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-mdas-link-1.inp" 
## Reading model:  cfa-mdas-link-1.out

MDAS item parameters linked

Comparision between original and linked item parameters for mdas
Item A (original) B (original) A (linked) B (linked)
rmdas01 2.51 1.98 2.33 2.00
rmdas02 2.12 0.94 1.97 0.88
rmdas03 1.45 0.05 1.34 -0.07
rmdas04 1.20 -0.94 1.11 -1.14
rmdas05 2.55 0.27 2.37 0.16
rmdas06 3.77 1.12 3.50 1.08
rmdas07 1.20 1.78 1.12 1.79
rmdas08 1.59 2.55 1.48 2.62
rmdas09 1.42 2.64 1.32 2.71
rmdas10 0.80 3.95 0.74 4.12
## 
## Running model: cfa-cam-link-1.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-cam-link-1.inp" 
## Reading model:  cfa-cam-link-1.out

CAM-S item parameters linked

Comparision between original and linked item parameters for cam
Item A (original) B (original) A (linked) B (linked)
rcamlf1a 2.61 0.80 2.44 0.75
rcamlf2a 2.45 -0.24 2.29 -0.36
rcamlf3a 3.92 1.11 3.66 1.09
rcamlf4a 1.95 2.46 1.82 2.53
rcamlf5a 2.27 0.92 2.12 0.88
rcamlf6a 1.96 0.81 1.83 0.77
rcamlf7a 1.36 1.76 1.27 1.78
rcamlf8a 1.65 2.87 1.54 2.97
rcamlf8d 1.01 4.07 0.94 4.26
rcamlf9a 0.73 4.17 0.68 4.36

Plots for the dichotomous model

Model Fitting (Polytomous model)

DRS CFA model with polytomous outcome

## Reading model:  cfa-drs-2-1-2pl.out 
## 
## Running model: cfa-drs-3-1.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-drs-3-1.inp" 
## Reading model:  cfa-drs-3-1.out
## Reading model:  cfa-drs-3-1.out
Item parameters for DRS with polytomous outcomes
Item A B1 B2 B3
rdrs01 0.93 -1.31 3.26 6.57
rdrs02 1.20 1.78 2.17 2.64
rdrs03 1.51 2.66 3.33 3.68
rdrs04 1.49 3.20 4.19 NA
rdrs05 1.59 1.68 3.40 4.44
rdrs06 3.54 1.22 1.80 2.94
rdrs07 1.63 2.88 4.06 NA
rdrs08 1.09 3.91 5.23 NA
rdrs09 1.75 0.96 1.80 3.98
rdrs10 2.66 -0.21 1.29 3.02
rdrs11 1.36 0.10 1.26 1.77
rdrs12 2.44 -0.13 0.63 1.08
rdrs13 1.61 1.71 3.10 5.16

MDAS CFA model with polytomous outcome

## Reading model:  cfa-mdas-link-1.out 
## 
## Running model: cfa-mdas-3-1.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-mdas-3-1.inp" 
## Reading model:  cfa-mdas-3-1.out
## Reading model:  cfa-mdas-3-1.out
Item parameters for MDAS with polytomous outcomes
Item A B1 B2 B3
rmdas01 2.33 2.00 2.97 NA
rmdas02 1.97 0.88 1.75 2.53
rmdas03 1.34 -0.07 1.02 2.59
rmdas04 1.11 -1.14 1.97 5.14
rmdas05 2.37 0.16 1.41 3.14
rmdas06 3.50 1.08 1.89 3.07
rmdas07 1.12 1.79 3.82 6.85
rmdas08 1.48 2.62 3.61 5.44
rmdas09 1.32 2.71 3.93 NA
rmdas10 0.74 -1.71 4.12 7.99

CAM-S CFA model with polytomous outcome

## Reading model:  cfa-cam-link-1.out 
## 
## Running model: cfa-cam-3-1.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-cam-3-1.inp" 
## Reading model:  cfa-cam-3-1.out
## Reading model:  cfa-cam-3-1.out
Item parameters for CAM with polytomous outcomes
Item A B1 B2
rcamlf1a 2.44 0.75 NA
rcamlf2a 2.29 -0.36 1.34
rcamlf3a 3.66 1.09 2.01
rcamlf4a 1.82 2.53 2.56
rcamlf5a 2.12 0.88 1.84
rcamlf6a 1.83 0.77 2.39
rcamlf7a 1.27 1.79 3.92
rcamlf8a 1.54 2.97 4.41
rcamlf8d 0.94 4.26 6.76
rcamlf9a 0.68 -1.82 4.35
## Reading model:  cfa-cam-link-1.out 
## 
## Running model: cfa-camsf-3-1.inp 
## System command: cd "." && "/Applications/Mplus/mplus" "cfa-camsf-3-1.inp" 
## Reading model:  cfa-camsf-3-1.out

Plots for the polytomous model

For the manuscript

This section contains tables/figures for the manuscript.

Table 1

Variable N Mean SD Count Percent
adlany 342 NA NA 272 79.5
age 352 80.3 6.8 NA NA
dementia 352 NA NA 101 28.7
educ 344 14.5 3.0 NA NA
female 352 NA NA 207 58.8
livesalone 348 NA NA 133 38.2
married 348 NA NA 139 39.9
nonwhite 352 NA NA 51 14.5
surgical 352 NA NA 102 29.0

Table 2

Summary of delirium severity instruments from all hospital interviews.
Variable N Mean SD Min Median Max
CAMS.LF 1178 2.3 2.4 0 1 14
CAMS.SF 1178 0.7 1.3 0 0 6
DRS 1178 4.7 4.3 0 3 28
MDAS 1178 3.9 3.3 0 3 22

Table 3

## Reading model:  cfa-drs-1-1-wlsmv.out 
## Reading model:  cfa-drs-2-1-wlsmv.out 
## Reading model:  cfa-mdas-1-1-wlsmv.out 
## Reading model:  cfa-mdas-2-1-wlsmv.out 
## Reading model:  cfa-cam-1-1-wlsmv.out 
## Reading model:  cfa-cam-2-1-wlsmv.out
Delirium Instrument CFI RMSEA
DRS (Model using only common features) 0.98 0.03
DRS (Model using all features) 0.97 0.08
MDAS (Model using only common features) 0.97 0.04
MDAS (Model using all features) 0.98 0.02
CAM-S (Model using only common features) 0.99 0.02
CAM-S (Model using all features) 0.92 0.09
* CFI = Confirmatory Fit Index, RMSEA = Root Mean Squared Error of Approximation
Values indicating good fit are: CFI>.9, RMSEA<.06

Figure 1

Figure 2

Figure 3

Figure 4

For the appendix

This section contains tables/figures for the appendix.

Figure A1: Nomogram

(The nomogram figures aren’t turning out well, so the tables they are based on are being provided.)

Table A1a: CAM-S LF table

CAM-S LF to MDAS, DRS, CAM-S SF
CAM-S LF MDAS DRS CAM-S SF
0 0.2 0.1 0.0
1 1.7 1.3 0.2
2 3.0 3.2 0.8
3 4.2 5.0 1.3
4 5.3 6.5 1.8
5 6.4 8.0 2.4
6 7.5 9.5 2.9
7 8.6 11.1 3.4
8 9.9 12.7 4.0
9 11.1 14.3 4.5
10 12.5 15.9 5.0
11 13.8 17.4 5.5
12 15.3 19.3 5.9
13 17.1 21.5 6.3
14 19.1 24.2 6.6
15 21.0 27.1 6.8
16 22.7 30.0 6.9
17 24.2 32.6 7.0
18 25.9 34.8 7.0
19 27.1 35.7 7.0

Table A1b: MDAS table

MDAS to CAM-S LF, DRS and CAM-S SF
MDAS CAM-S LF DRS CAM-S SF
0 0.2 0.1 0.0
1 0.6 0.6 0.0
2 1.2 1.6 0.3
3 2.0 3.1 0.8
4 2.8 4.6 1.2
5 3.7 6.1 1.7
6 4.6 7.5 2.1
7 5.6 8.9 2.7
8 6.4 10.2 3.1
9 7.3 11.6 3.6
10 8.1 12.9 4.0
11 8.9 14.1 4.4
12 9.7 15.3 4.8
13 10.4 16.5 5.2
14 11.1 17.7 5.5
15 11.8 18.9 5.8
16 12.4 20.1 6.1
17 13.0 21.5 6.3
18 13.5 22.7 6.4
19 13.9 24.0 6.6
20 14.4 25.5 6.7
21 15.0 27.1 6.8
22 15.6 28.7 6.9
23 16.2 30.6 6.9
24 16.9 32.4 7.0
25 17.5 33.8 7.0
26 18.0 34.9 7.0
27 18.6 35.6 7.0

Table A1c: DRS table

DRS to CAM-S LF, MDAS and CAM-S SF
DRS CAM-S LF MDAS CAM-S SF
0 0.2 0.2 0.0
1 0.8 1.5 0.1
2 1.4 2.3 0.5
3 1.9 2.9 0.7
4 2.4 3.6 1.0
5 3.0 4.2 1.3
6 3.6 4.9 1.6
7 4.3 5.7 2.0
8 5.0 6.4 2.3
9 5.6 7.1 2.7
10 6.3 7.8 3.1
11 6.9 8.5 3.4
12 7.6 9.3 3.7
13 8.2 10.1 4.1
14 8.8 10.9 4.4
15 9.4 11.7 4.7
16 10.1 12.6 5.0
17 10.7 13.4 5.3
18 11.3 14.3 5.6
19 11.9 15.1 5.9
20 12.3 15.9 6.0
21 12.8 16.6 6.2
22 13.2 17.5 6.3
23 13.6 18.2 6.5
24 13.9 18.9 6.6
25 14.3 19.7 6.7
26 14.6 20.4 6.7
27 15.0 21.0 6.8
28 15.3 21.6 6.9
29 15.7 22.1 6.9
30 16.0 22.7 6.9
31 16.4 23.2 7.0
32 16.7 23.8 7.0
33 17.1 24.4 7.0
34 17.6 25.1 7.0
35 18.1 26.1 7.0
36 18.6 27.1 7.0

Table A1d: CAM-S SF table

CAM-S SF to MDAS, DRS, CAM-S LF
CAM-S SF MDAS DRS CAM-S LF
0 0.2 0.1 0.2
1 3.5 3.9 2.4
2 5.7 7.1 4.3
3 7.7 9.8 6.2
4 10.0 12.9 8.1
5 12.5 15.9 10.0
6 15.7 19.8 12.2
7 27.1 35.7 18.6

Figure A1a: CAM-S LF nomogram with MDAS and DRS

Figure A1b: CAM-S LF nomogram with CAM-S SF and DRS

Figure A1c: CAM-S LF nomogram with CAM-S SF and MDAS

Figure A2a: MDAS nomogram with CAM-S LF and DRS

Figure A2b: MDAS nomogram with CAM-S SF and DRS

Figure A2c: MDAS nomogram with CAM-S SF and CAM-S LF

Figure A3a: DRS nomogram with MDAS and CAM-S LF

Figure A3b: DRS nomogram with MDAS and CAM-S SF

Figure A3c: DRS nomogram with CAM-S LF and CAM-S SF

Figure A4a: CAM-S SF nomogram with MDAS and DRS

Figure A4b: CAM-S SF nomogram with MDAS and CAM-S LF

Figure A4c: CAM-S SF nomogram with DRS and CAM-S LF

Sensitivity analysis for the non-independence of observations

This sensitivity analysis addresses concerns of the non-independence of multiple observations across subjects. In this analysis we randomly sampled one observation for each subject and then refit the first two CFA models. This was repeated 500 times. The parameter estimates from the n=1178 observations are then compared to this bootstrap-like distribution of parameter estimates.

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## Reading model:  cfa-drs-boot-2-50-2pl.out 
## Reading model:  cfa-drs-boot-2-500-2pl.out 
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## Reading model:  cfa-drs-boot-2-62-2pl.out 
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## Reading model:  cfa-drs-boot-2-66-2pl.out 
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## Reading model:  cfa-drs-boot-2-91-2pl.out 
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## Reading model:  cfa-drs-boot-2-93-2pl.out 
## Reading model:  cfa-drs-boot-2-94-2pl.out 
## Reading model:  cfa-drs-boot-2-95-2pl.out 
## Reading model:  cfa-drs-boot-2-96-2pl.out 
## Reading model:  cfa-drs-boot-2-97-2pl.out 
## Reading model:  cfa-drs-boot-2-98-2pl.out 
## Reading model:  cfa-drs-boot-2-99-2pl.out
Summary of A parameters for the DRS
Item Full sample parameter estimate Mean SD Min p25 Median p75 Max
rdrs01 0.93 0.81 0.19 0.26 0.66 0.80 0.95 1.44
rdrs02 1.20 1.13 0.16 0.73 1.01 1.12 1.23 1.78
rdrs03 1.51 1.70 0.37 0.94 1.44 1.66 1.91 3.68
rdrs04 1.49 1.34 0.29 0.59 1.15 1.32 1.55 2.09
rdrs05 1.59 1.41 0.16 0.98 1.30 1.41 1.51 1.97
rdrs06 3.54 4.28 2.21 2.25 3.10 3.64 4.52 18.31
rdrs07 1.63 1.27 0.17 0.80 1.16 1.27 1.39 1.78
rdrs08 1.09 1.43 0.33 0.40 1.21 1.41 1.61 2.91
rdrs09 1.75 1.88 0.26 1.25 1.70 1.87 2.04 2.77
rdrs10 2.66 2.65 0.49 1.75 2.32 2.55 2.91 4.66
rdrs11 1.36 1.44 0.20 0.96 1.30 1.41 1.55 2.37
rdrs12 2.44 4.94 26.20 1.48 2.36 2.82 3.35 497.60
rdrs13 1.61 1.56 0.18 1.05 1.43 1.55 1.67 2.17
Summary of B parameters for the DRS
Item Full sample parameter estimate Mean SD Min p25 Median p75 Max
rdrs01 3.26 3.82 0.93 2.31 3.16 3.60 4.28 10.40
rdrs02 1.78 2.01 0.22 1.54 1.85 1.99 2.14 2.78
rdrs03 2.66 2.56 0.32 1.88 2.33 2.53 2.74 3.73
rdrs04 3.20 3.59 0.63 2.57 3.15 3.47 3.89 6.76
rdrs05 1.68 1.61 0.13 1.23 1.52 1.60 1.69 2.10
rdrs06 1.22 1.21 0.08 1.03 1.16 1.21 1.26 1.47
rdrs07 2.88 3.14 0.37 2.37 2.88 3.08 3.34 4.90
rdrs08 3.91 3.45 0.65 2.17 3.03 3.32 3.72 9.96
rdrs09 0.96 0.96 0.08 0.75 0.91 0.95 1.01 1.26
rdrs10 -0.21 -0.22 0.05 -0.36 -0.25 -0.22 -0.19 -0.05
rdrs11 0.10 -0.16 0.06 -0.36 -0.20 -0.16 -0.12 0.03
rdrs12 -0.13 -0.31 0.05 -0.51 -0.34 -0.31 -0.27 -0.16
rdrs13 1.71 1.48 0.13 1.13 1.40 1.47 1.57 1.95

## Reading model:  cfa-mdas-boot-2-1-2pl.out 
## Reading model:  cfa-mdas-boot-2-10-2pl.out 
## Reading model:  cfa-mdas-boot-2-100-2pl.out 
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## Reading model:  cfa-mdas-boot-2-17-2pl.out 
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## Reading model:  cfa-mdas-boot-2-18-2pl.out 
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## Reading model:  cfa-mdas-boot-2-19-2pl.out 
## Reading model:  cfa-mdas-boot-2-190-2pl.out 
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## Reading model:  cfa-mdas-boot-2-3-2pl.out 
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## Reading model:  cfa-mdas-boot-2-58-2pl.out 
## Reading model:  cfa-mdas-boot-2-59-2pl.out 
## Reading model:  cfa-mdas-boot-2-6-2pl.out 
## Reading model:  cfa-mdas-boot-2-60-2pl.out 
## Reading model:  cfa-mdas-boot-2-61-2pl.out 
## Reading model:  cfa-mdas-boot-2-62-2pl.out 
## Reading model:  cfa-mdas-boot-2-63-2pl.out 
## Reading model:  cfa-mdas-boot-2-64-2pl.out 
## Reading model:  cfa-mdas-boot-2-65-2pl.out 
## Reading model:  cfa-mdas-boot-2-66-2pl.out 
## Reading model:  cfa-mdas-boot-2-67-2pl.out 
## Reading model:  cfa-mdas-boot-2-68-2pl.out 
## Reading model:  cfa-mdas-boot-2-69-2pl.out 
## Reading model:  cfa-mdas-boot-2-7-2pl.out 
## Reading model:  cfa-mdas-boot-2-70-2pl.out 
## Reading model:  cfa-mdas-boot-2-71-2pl.out 
## Reading model:  cfa-mdas-boot-2-72-2pl.out 
## Reading model:  cfa-mdas-boot-2-73-2pl.out 
## Reading model:  cfa-mdas-boot-2-74-2pl.out 
## Reading model:  cfa-mdas-boot-2-75-2pl.out 
## Reading model:  cfa-mdas-boot-2-76-2pl.out 
## Reading model:  cfa-mdas-boot-2-77-2pl.out 
## Reading model:  cfa-mdas-boot-2-78-2pl.out 
## Reading model:  cfa-mdas-boot-2-79-2pl.out 
## Reading model:  cfa-mdas-boot-2-8-2pl.out 
## Reading model:  cfa-mdas-boot-2-80-2pl.out 
## Reading model:  cfa-mdas-boot-2-81-2pl.out 
## Reading model:  cfa-mdas-boot-2-82-2pl.out 
## Reading model:  cfa-mdas-boot-2-83-2pl.out 
## Reading model:  cfa-mdas-boot-2-84-2pl.out 
## Reading model:  cfa-mdas-boot-2-85-2pl.out 
## Reading model:  cfa-mdas-boot-2-86-2pl.out 
## Reading model:  cfa-mdas-boot-2-87-2pl.out 
## Reading model:  cfa-mdas-boot-2-88-2pl.out 
## Reading model:  cfa-mdas-boot-2-89-2pl.out 
## Reading model:  cfa-mdas-boot-2-9-2pl.out 
## Reading model:  cfa-mdas-boot-2-90-2pl.out 
## Reading model:  cfa-mdas-boot-2-91-2pl.out 
## Reading model:  cfa-mdas-boot-2-92-2pl.out 
## Reading model:  cfa-mdas-boot-2-93-2pl.out 
## Reading model:  cfa-mdas-boot-2-94-2pl.out 
## Reading model:  cfa-mdas-boot-2-95-2pl.out 
## Reading model:  cfa-mdas-boot-2-96-2pl.out 
## Reading model:  cfa-mdas-boot-2-97-2pl.out 
## Reading model:  cfa-mdas-boot-2-98-2pl.out 
## Reading model:  cfa-mdas-boot-2-99-2pl.out
Summary of A parameters for the MDAS
Item Full sample parameter estimate Mean SD Min p25 Median p75 Max
rmdas01 2.51 2.94 0.89 1.62 2.46 2.75 3.21 12.71
rmdas02 2.12 2.39 0.33 1.64 2.16 2.36 2.56 3.76
rmdas03 1.45 1.50 0.20 0.95 1.37 1.48 1.62 2.44
rmdas04 1.20 1.08 0.14 0.71 0.99 1.07 1.17 1.57
rmdas05 2.55 2.84 0.36 2.04 2.58 2.80 3.03 4.58
rmdas06 3.77 26.09 455.43 2.72 3.74 4.42 5.67 10189.13
rmdas07 1.20 1.17 0.17 0.78 1.06 1.16 1.27 1.78
rmdas08 1.59 1.85 0.38 1.03 1.59 1.81 2.05 4.13
rmdas09 1.42 1.35 0.21 0.81 1.20 1.35 1.49 1.89
rmdas10 0.80 0.84 0.17 0.32 0.73 0.83 0.94 1.44
Summary of B parameters for the MDAS
Item Full sample parameter estimate Mean SD Min p25 Median p75 Max
rmdas01 1.98 1.94 0.15 1.62 1.85 1.93 2.01 2.52
rmdas02 0.94 0.94 0.06 0.79 0.90 0.94 0.98 1.18
rmdas03 0.05 -0.18 0.06 -0.38 -0.22 -0.18 -0.14 0.01
rmdas04 -0.94 -1.10 0.14 -1.57 -1.18 -1.08 -1.00 -0.74
rmdas05 0.27 0.26 0.04 0.13 0.23 0.26 0.29 0.44
rmdas06 1.12 1.06 0.06 0.92 1.01 1.05 1.09 1.25
rmdas07 1.78 1.95 0.21 1.45 1.80 1.92 2.07 2.74
rmdas08 2.55 2.40 0.26 1.83 2.21 2.37 2.56 3.68
rmdas09 2.64 2.66 0.33 1.95 2.43 2.60 2.83 3.95
rmdas10 3.95 3.80 0.75 2.44 3.29 3.69 4.09 8.57

## Reading model:  cfa-cam-boot-2-1-2pl.out 
## Reading model:  cfa-cam-boot-2-10-2pl.out 
## Reading model:  cfa-cam-boot-2-100-2pl.out 
## Reading model:  cfa-cam-boot-2-101-2pl.out 
## Reading model:  cfa-cam-boot-2-102-2pl.out 
## Reading model:  cfa-cam-boot-2-103-2pl.out 
## Reading model:  cfa-cam-boot-2-104-2pl.out 
## Reading model:  cfa-cam-boot-2-105-2pl.out 
## Reading model:  cfa-cam-boot-2-106-2pl.out 
## Reading model:  cfa-cam-boot-2-107-2pl.out 
## Reading model:  cfa-cam-boot-2-108-2pl.out 
## Reading model:  cfa-cam-boot-2-109-2pl.out 
## Reading model:  cfa-cam-boot-2-11-2pl.out 
## Reading model:  cfa-cam-boot-2-110-2pl.out 
## Reading model:  cfa-cam-boot-2-111-2pl.out 
## Reading model:  cfa-cam-boot-2-112-2pl.out 
## Reading model:  cfa-cam-boot-2-113-2pl.out 
## Reading model:  cfa-cam-boot-2-114-2pl.out 
## Reading model:  cfa-cam-boot-2-115-2pl.out 
## Reading model:  cfa-cam-boot-2-116-2pl.out 
## Reading model:  cfa-cam-boot-2-117-2pl.out 
## Reading model:  cfa-cam-boot-2-118-2pl.out 
## Reading model:  cfa-cam-boot-2-119-2pl.out 
## Reading model:  cfa-cam-boot-2-12-2pl.out 
## Reading model:  cfa-cam-boot-2-120-2pl.out 
## Reading model:  cfa-cam-boot-2-121-2pl.out 
## Reading model:  cfa-cam-boot-2-122-2pl.out 
## Reading model:  cfa-cam-boot-2-123-2pl.out 
## Reading model:  cfa-cam-boot-2-124-2pl.out 
## Reading model:  cfa-cam-boot-2-125-2pl.out 
## Reading model:  cfa-cam-boot-2-126-2pl.out 
## Reading model:  cfa-cam-boot-2-127-2pl.out 
## Reading model:  cfa-cam-boot-2-128-2pl.out 
## Reading model:  cfa-cam-boot-2-129-2pl.out 
## Reading model:  cfa-cam-boot-2-13-2pl.out 
## Reading model:  cfa-cam-boot-2-130-2pl.out 
## Reading model:  cfa-cam-boot-2-131-2pl.out 
## Reading model:  cfa-cam-boot-2-132-2pl.out 
## Reading model:  cfa-cam-boot-2-133-2pl.out 
## Reading model:  cfa-cam-boot-2-134-2pl.out 
## Reading model:  cfa-cam-boot-2-135-2pl.out 
## Reading model:  cfa-cam-boot-2-136-2pl.out 
## Reading model:  cfa-cam-boot-2-137-2pl.out 
## Reading model:  cfa-cam-boot-2-138-2pl.out 
## Reading model:  cfa-cam-boot-2-139-2pl.out 
## Reading model:  cfa-cam-boot-2-14-2pl.out 
## Reading model:  cfa-cam-boot-2-140-2pl.out 
## Reading model:  cfa-cam-boot-2-141-2pl.out 
## Reading model:  cfa-cam-boot-2-142-2pl.out 
## Reading model:  cfa-cam-boot-2-143-2pl.out 
## Reading model:  cfa-cam-boot-2-144-2pl.out 
## Reading model:  cfa-cam-boot-2-145-2pl.out 
## Reading model:  cfa-cam-boot-2-146-2pl.out 
## Reading model:  cfa-cam-boot-2-147-2pl.out 
## Reading model:  cfa-cam-boot-2-148-2pl.out 
## Reading model:  cfa-cam-boot-2-149-2pl.out 
## Reading model:  cfa-cam-boot-2-15-2pl.out 
## Reading model:  cfa-cam-boot-2-150-2pl.out 
## Reading model:  cfa-cam-boot-2-151-2pl.out 
## Reading model:  cfa-cam-boot-2-152-2pl.out 
## Reading model:  cfa-cam-boot-2-153-2pl.out 
## Reading model:  cfa-cam-boot-2-154-2pl.out 
## Reading model:  cfa-cam-boot-2-155-2pl.out 
## Reading model:  cfa-cam-boot-2-156-2pl.out 
## Reading model:  cfa-cam-boot-2-157-2pl.out 
## Reading model:  cfa-cam-boot-2-158-2pl.out 
## Reading model:  cfa-cam-boot-2-159-2pl.out 
## Reading model:  cfa-cam-boot-2-16-2pl.out 
## Reading model:  cfa-cam-boot-2-160-2pl.out 
## Reading model:  cfa-cam-boot-2-161-2pl.out 
## Reading model:  cfa-cam-boot-2-162-2pl.out 
## Reading model:  cfa-cam-boot-2-163-2pl.out 
## Reading model:  cfa-cam-boot-2-164-2pl.out 
## Reading model:  cfa-cam-boot-2-165-2pl.out 
## Reading model:  cfa-cam-boot-2-166-2pl.out 
## Reading model:  cfa-cam-boot-2-167-2pl.out 
## Reading model:  cfa-cam-boot-2-168-2pl.out 
## Reading model:  cfa-cam-boot-2-169-2pl.out 
## Reading model:  cfa-cam-boot-2-17-2pl.out 
## Reading model:  cfa-cam-boot-2-170-2pl.out 
## Reading model:  cfa-cam-boot-2-171-2pl.out 
## Reading model:  cfa-cam-boot-2-172-2pl.out 
## Reading model:  cfa-cam-boot-2-173-2pl.out 
## Reading model:  cfa-cam-boot-2-174-2pl.out 
## Reading model:  cfa-cam-boot-2-175-2pl.out 
## Reading model:  cfa-cam-boot-2-176-2pl.out 
## Reading model:  cfa-cam-boot-2-177-2pl.out 
## Reading model:  cfa-cam-boot-2-178-2pl.out 
## Reading model:  cfa-cam-boot-2-179-2pl.out 
## Reading model:  cfa-cam-boot-2-18-2pl.out 
## Reading model:  cfa-cam-boot-2-180-2pl.out 
## Reading model:  cfa-cam-boot-2-181-2pl.out 
## Reading model:  cfa-cam-boot-2-182-2pl.out 
## Reading model:  cfa-cam-boot-2-183-2pl.out 
## Reading model:  cfa-cam-boot-2-184-2pl.out 
## Reading model:  cfa-cam-boot-2-185-2pl.out 
## Reading model:  cfa-cam-boot-2-186-2pl.out 
## Reading model:  cfa-cam-boot-2-187-2pl.out 
## Reading model:  cfa-cam-boot-2-188-2pl.out 
## Reading model:  cfa-cam-boot-2-189-2pl.out 
## Reading model:  cfa-cam-boot-2-19-2pl.out 
## Reading model:  cfa-cam-boot-2-190-2pl.out 
## Reading model:  cfa-cam-boot-2-191-2pl.out 
## Reading model:  cfa-cam-boot-2-192-2pl.out 
## Reading model:  cfa-cam-boot-2-193-2pl.out 
## Reading model:  cfa-cam-boot-2-194-2pl.out 
## Reading model:  cfa-cam-boot-2-195-2pl.out 
## Reading model:  cfa-cam-boot-2-196-2pl.out 
## Reading model:  cfa-cam-boot-2-197-2pl.out 
## Reading model:  cfa-cam-boot-2-198-2pl.out 
## Reading model:  cfa-cam-boot-2-199-2pl.out 
## Reading model:  cfa-cam-boot-2-2-2pl.out 
## Reading model:  cfa-cam-boot-2-20-2pl.out 
## Reading model:  cfa-cam-boot-2-200-2pl.out 
## Reading model:  cfa-cam-boot-2-201-2pl.out 
## Reading model:  cfa-cam-boot-2-202-2pl.out 
## Reading model:  cfa-cam-boot-2-203-2pl.out 
## Reading model:  cfa-cam-boot-2-204-2pl.out 
## Reading model:  cfa-cam-boot-2-205-2pl.out 
## Reading model:  cfa-cam-boot-2-206-2pl.out 
## Reading model:  cfa-cam-boot-2-207-2pl.out 
## Reading model:  cfa-cam-boot-2-208-2pl.out 
## Reading model:  cfa-cam-boot-2-209-2pl.out 
## Reading model:  cfa-cam-boot-2-21-2pl.out 
## Reading model:  cfa-cam-boot-2-210-2pl.out 
## Reading model:  cfa-cam-boot-2-211-2pl.out 
## Reading model:  cfa-cam-boot-2-212-2pl.out 
## Reading model:  cfa-cam-boot-2-213-2pl.out 
## Reading model:  cfa-cam-boot-2-214-2pl.out 
## Reading model:  cfa-cam-boot-2-215-2pl.out 
## Reading model:  cfa-cam-boot-2-216-2pl.out 
## Reading model:  cfa-cam-boot-2-217-2pl.out 
## Reading model:  cfa-cam-boot-2-218-2pl.out 
## Reading model:  cfa-cam-boot-2-219-2pl.out 
## Reading model:  cfa-cam-boot-2-22-2pl.out 
## Reading model:  cfa-cam-boot-2-220-2pl.out 
## Reading model:  cfa-cam-boot-2-221-2pl.out 
## Reading model:  cfa-cam-boot-2-222-2pl.out 
## Reading model:  cfa-cam-boot-2-223-2pl.out 
## Reading model:  cfa-cam-boot-2-224-2pl.out 
## Reading model:  cfa-cam-boot-2-225-2pl.out 
## Reading model:  cfa-cam-boot-2-226-2pl.out 
## Reading model:  cfa-cam-boot-2-227-2pl.out 
## Reading model:  cfa-cam-boot-2-228-2pl.out 
## Reading model:  cfa-cam-boot-2-229-2pl.out 
## Reading model:  cfa-cam-boot-2-23-2pl.out 
## Reading model:  cfa-cam-boot-2-230-2pl.out 
## Reading model:  cfa-cam-boot-2-231-2pl.out 
## Reading model:  cfa-cam-boot-2-232-2pl.out 
## Reading model:  cfa-cam-boot-2-233-2pl.out 
## Reading model:  cfa-cam-boot-2-234-2pl.out 
## Reading model:  cfa-cam-boot-2-235-2pl.out 
## Reading model:  cfa-cam-boot-2-236-2pl.out 
## Reading model:  cfa-cam-boot-2-237-2pl.out 
## Reading model:  cfa-cam-boot-2-238-2pl.out 
## Reading model:  cfa-cam-boot-2-239-2pl.out 
## Reading model:  cfa-cam-boot-2-24-2pl.out 
## Reading model:  cfa-cam-boot-2-240-2pl.out 
## Reading model:  cfa-cam-boot-2-241-2pl.out 
## Reading model:  cfa-cam-boot-2-242-2pl.out 
## Reading model:  cfa-cam-boot-2-243-2pl.out 
## Reading model:  cfa-cam-boot-2-244-2pl.out 
## Reading model:  cfa-cam-boot-2-245-2pl.out 
## Reading model:  cfa-cam-boot-2-246-2pl.out 
## Reading model:  cfa-cam-boot-2-247-2pl.out 
## Reading model:  cfa-cam-boot-2-248-2pl.out 
## Reading model:  cfa-cam-boot-2-249-2pl.out 
## Reading model:  cfa-cam-boot-2-25-2pl.out 
## Reading model:  cfa-cam-boot-2-250-2pl.out 
## Reading model:  cfa-cam-boot-2-251-2pl.out 
## Reading model:  cfa-cam-boot-2-252-2pl.out 
## Reading model:  cfa-cam-boot-2-253-2pl.out 
## Reading model:  cfa-cam-boot-2-254-2pl.out 
## Reading model:  cfa-cam-boot-2-255-2pl.out 
## Reading model:  cfa-cam-boot-2-256-2pl.out 
## Reading model:  cfa-cam-boot-2-257-2pl.out 
## Reading model:  cfa-cam-boot-2-258-2pl.out 
## Reading model:  cfa-cam-boot-2-259-2pl.out 
## Reading model:  cfa-cam-boot-2-26-2pl.out 
## Reading model:  cfa-cam-boot-2-260-2pl.out 
## Reading model:  cfa-cam-boot-2-261-2pl.out 
## Reading model:  cfa-cam-boot-2-262-2pl.out 
## Reading model:  cfa-cam-boot-2-263-2pl.out 
## Reading model:  cfa-cam-boot-2-264-2pl.out 
## Reading model:  cfa-cam-boot-2-265-2pl.out 
## Reading model:  cfa-cam-boot-2-266-2pl.out 
## Reading model:  cfa-cam-boot-2-267-2pl.out 
## Reading model:  cfa-cam-boot-2-268-2pl.out 
## Reading model:  cfa-cam-boot-2-269-2pl.out 
## Reading model:  cfa-cam-boot-2-27-2pl.out 
## Reading model:  cfa-cam-boot-2-270-2pl.out 
## Reading model:  cfa-cam-boot-2-271-2pl.out 
## Reading model:  cfa-cam-boot-2-272-2pl.out 
## Reading model:  cfa-cam-boot-2-273-2pl.out 
## Reading model:  cfa-cam-boot-2-274-2pl.out 
## Reading model:  cfa-cam-boot-2-275-2pl.out 
## Reading model:  cfa-cam-boot-2-276-2pl.out 
## Reading model:  cfa-cam-boot-2-277-2pl.out 
## Reading model:  cfa-cam-boot-2-278-2pl.out 
## Reading model:  cfa-cam-boot-2-279-2pl.out 
## Reading model:  cfa-cam-boot-2-28-2pl.out 
## Reading model:  cfa-cam-boot-2-280-2pl.out 
## Reading model:  cfa-cam-boot-2-281-2pl.out 
## Reading model:  cfa-cam-boot-2-282-2pl.out 
## Reading model:  cfa-cam-boot-2-283-2pl.out 
## Reading model:  cfa-cam-boot-2-284-2pl.out 
## Reading model:  cfa-cam-boot-2-285-2pl.out 
## Reading model:  cfa-cam-boot-2-286-2pl.out 
## Reading model:  cfa-cam-boot-2-287-2pl.out 
## Reading model:  cfa-cam-boot-2-288-2pl.out 
## Reading model:  cfa-cam-boot-2-289-2pl.out 
## Reading model:  cfa-cam-boot-2-29-2pl.out 
## Reading model:  cfa-cam-boot-2-290-2pl.out 
## Reading model:  cfa-cam-boot-2-291-2pl.out 
## Reading model:  cfa-cam-boot-2-292-2pl.out 
## Reading model:  cfa-cam-boot-2-293-2pl.out 
## Reading model:  cfa-cam-boot-2-294-2pl.out 
## Reading model:  cfa-cam-boot-2-295-2pl.out 
## Reading model:  cfa-cam-boot-2-296-2pl.out 
## Reading model:  cfa-cam-boot-2-297-2pl.out 
## Reading model:  cfa-cam-boot-2-298-2pl.out 
## Reading model:  cfa-cam-boot-2-299-2pl.out 
## Reading model:  cfa-cam-boot-2-3-2pl.out 
## Reading model:  cfa-cam-boot-2-30-2pl.out 
## Reading model:  cfa-cam-boot-2-300-2pl.out 
## Reading model:  cfa-cam-boot-2-301-2pl.out 
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## Reading model:  cfa-cam-boot-2-303-2pl.out 
## Reading model:  cfa-cam-boot-2-304-2pl.out 
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## Reading model:  cfa-cam-boot-2-306-2pl.out 
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## Reading model:  cfa-cam-boot-2-308-2pl.out 
## Reading model:  cfa-cam-boot-2-309-2pl.out 
## Reading model:  cfa-cam-boot-2-31-2pl.out 
## Reading model:  cfa-cam-boot-2-310-2pl.out 
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## Reading model:  cfa-cam-boot-2-312-2pl.out 
## Reading model:  cfa-cam-boot-2-313-2pl.out 
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## Reading model:  cfa-cam-boot-2-315-2pl.out 
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## Reading model:  cfa-cam-boot-2-32-2pl.out 
## Reading model:  cfa-cam-boot-2-320-2pl.out 
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## Reading model:  cfa-cam-boot-2-362-2pl.out 
## Reading model:  cfa-cam-boot-2-363-2pl.out 
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## Reading model:  cfa-cam-boot-2-399-2pl.out 
## Reading model:  cfa-cam-boot-2-4-2pl.out 
## Reading model:  cfa-cam-boot-2-40-2pl.out 
## Reading model:  cfa-cam-boot-2-400-2pl.out 
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## Reading model:  cfa-cam-boot-2-41-2pl.out 
## Reading model:  cfa-cam-boot-2-410-2pl.out 
## Reading model:  cfa-cam-boot-2-411-2pl.out 
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## Reading model:  cfa-cam-boot-2-416-2pl.out 
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## Reading model:  cfa-cam-boot-2-419-2pl.out 
## Reading model:  cfa-cam-boot-2-42-2pl.out 
## Reading model:  cfa-cam-boot-2-420-2pl.out 
## Reading model:  cfa-cam-boot-2-421-2pl.out 
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## Reading model:  cfa-cam-boot-2-425-2pl.out 
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## Reading model:  cfa-cam-boot-2-429-2pl.out 
## Reading model:  cfa-cam-boot-2-43-2pl.out 
## Reading model:  cfa-cam-boot-2-430-2pl.out 
## Reading model:  cfa-cam-boot-2-431-2pl.out 
## Reading model:  cfa-cam-boot-2-432-2pl.out 
## Reading model:  cfa-cam-boot-2-433-2pl.out 
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## Reading model:  cfa-cam-boot-2-435-2pl.out 
## Reading model:  cfa-cam-boot-2-436-2pl.out 
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## Reading model:  cfa-cam-boot-2-44-2pl.out 
## Reading model:  cfa-cam-boot-2-440-2pl.out 
## Reading model:  cfa-cam-boot-2-441-2pl.out 
## Reading model:  cfa-cam-boot-2-442-2pl.out 
## Reading model:  cfa-cam-boot-2-443-2pl.out 
## Reading model:  cfa-cam-boot-2-444-2pl.out 
## Reading model:  cfa-cam-boot-2-445-2pl.out 
## Reading model:  cfa-cam-boot-2-446-2pl.out 
## Reading model:  cfa-cam-boot-2-447-2pl.out 
## Reading model:  cfa-cam-boot-2-448-2pl.out 
## Reading model:  cfa-cam-boot-2-449-2pl.out 
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## Reading model:  cfa-cam-boot-2-451-2pl.out 
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## Reading model:  cfa-cam-boot-2-453-2pl.out 
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## Reading model:  cfa-cam-boot-2-455-2pl.out 
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## Reading model:  cfa-cam-boot-2-457-2pl.out 
## Reading model:  cfa-cam-boot-2-458-2pl.out 
## Reading model:  cfa-cam-boot-2-459-2pl.out 
## Reading model:  cfa-cam-boot-2-46-2pl.out 
## Reading model:  cfa-cam-boot-2-460-2pl.out 
## Reading model:  cfa-cam-boot-2-461-2pl.out 
## Reading model:  cfa-cam-boot-2-462-2pl.out 
## Reading model:  cfa-cam-boot-2-463-2pl.out 
## Reading model:  cfa-cam-boot-2-464-2pl.out 
## Reading model:  cfa-cam-boot-2-465-2pl.out 
## Reading model:  cfa-cam-boot-2-466-2pl.out 
## Reading model:  cfa-cam-boot-2-467-2pl.out 
## Reading model:  cfa-cam-boot-2-468-2pl.out 
## Reading model:  cfa-cam-boot-2-469-2pl.out 
## Reading model:  cfa-cam-boot-2-47-2pl.out 
## Reading model:  cfa-cam-boot-2-470-2pl.out 
## Reading model:  cfa-cam-boot-2-471-2pl.out 
## Reading model:  cfa-cam-boot-2-472-2pl.out 
## Reading model:  cfa-cam-boot-2-473-2pl.out 
## Reading model:  cfa-cam-boot-2-474-2pl.out 
## Reading model:  cfa-cam-boot-2-475-2pl.out 
## Reading model:  cfa-cam-boot-2-476-2pl.out 
## Reading model:  cfa-cam-boot-2-477-2pl.out 
## Reading model:  cfa-cam-boot-2-478-2pl.out 
## Reading model:  cfa-cam-boot-2-479-2pl.out 
## Reading model:  cfa-cam-boot-2-48-2pl.out 
## Reading model:  cfa-cam-boot-2-480-2pl.out 
## Reading model:  cfa-cam-boot-2-481-2pl.out 
## Reading model:  cfa-cam-boot-2-482-2pl.out 
## Reading model:  cfa-cam-boot-2-483-2pl.out 
## Reading model:  cfa-cam-boot-2-484-2pl.out 
## Reading model:  cfa-cam-boot-2-485-2pl.out 
## Reading model:  cfa-cam-boot-2-486-2pl.out 
## Reading model:  cfa-cam-boot-2-487-2pl.out 
## Reading model:  cfa-cam-boot-2-488-2pl.out 
## Reading model:  cfa-cam-boot-2-489-2pl.out 
## Reading model:  cfa-cam-boot-2-49-2pl.out 
## Reading model:  cfa-cam-boot-2-490-2pl.out 
## Reading model:  cfa-cam-boot-2-491-2pl.out 
## Reading model:  cfa-cam-boot-2-492-2pl.out 
## Reading model:  cfa-cam-boot-2-493-2pl.out 
## Reading model:  cfa-cam-boot-2-494-2pl.out 
## Reading model:  cfa-cam-boot-2-495-2pl.out 
## Reading model:  cfa-cam-boot-2-496-2pl.out 
## Reading model:  cfa-cam-boot-2-497-2pl.out 
## Reading model:  cfa-cam-boot-2-498-2pl.out 
## Reading model:  cfa-cam-boot-2-499-2pl.out 
## Reading model:  cfa-cam-boot-2-5-2pl.out 
## Reading model:  cfa-cam-boot-2-50-2pl.out 
## Reading model:  cfa-cam-boot-2-500-2pl.out 
## Reading model:  cfa-cam-boot-2-51-2pl.out 
## Reading model:  cfa-cam-boot-2-52-2pl.out 
## Reading model:  cfa-cam-boot-2-53-2pl.out 
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## Reading model:  cfa-cam-boot-2-55-2pl.out 
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## Reading model:  cfa-cam-boot-2-57-2pl.out 
## Reading model:  cfa-cam-boot-2-58-2pl.out 
## Reading model:  cfa-cam-boot-2-59-2pl.out 
## Reading model:  cfa-cam-boot-2-6-2pl.out 
## Reading model:  cfa-cam-boot-2-60-2pl.out 
## Reading model:  cfa-cam-boot-2-61-2pl.out 
## Reading model:  cfa-cam-boot-2-62-2pl.out 
## Reading model:  cfa-cam-boot-2-63-2pl.out 
## Reading model:  cfa-cam-boot-2-64-2pl.out 
## Reading model:  cfa-cam-boot-2-65-2pl.out 
## Reading model:  cfa-cam-boot-2-66-2pl.out 
## Reading model:  cfa-cam-boot-2-67-2pl.out 
## Reading model:  cfa-cam-boot-2-68-2pl.out 
## Reading model:  cfa-cam-boot-2-69-2pl.out 
## Reading model:  cfa-cam-boot-2-7-2pl.out 
## Reading model:  cfa-cam-boot-2-70-2pl.out 
## Reading model:  cfa-cam-boot-2-71-2pl.out 
## Reading model:  cfa-cam-boot-2-72-2pl.out 
## Reading model:  cfa-cam-boot-2-73-2pl.out 
## Reading model:  cfa-cam-boot-2-74-2pl.out 
## Reading model:  cfa-cam-boot-2-75-2pl.out 
## Reading model:  cfa-cam-boot-2-76-2pl.out 
## Reading model:  cfa-cam-boot-2-77-2pl.out 
## Reading model:  cfa-cam-boot-2-78-2pl.out 
## Reading model:  cfa-cam-boot-2-79-2pl.out 
## Reading model:  cfa-cam-boot-2-8-2pl.out 
## Reading model:  cfa-cam-boot-2-80-2pl.out 
## Reading model:  cfa-cam-boot-2-81-2pl.out 
## Reading model:  cfa-cam-boot-2-82-2pl.out 
## Reading model:  cfa-cam-boot-2-83-2pl.out 
## Reading model:  cfa-cam-boot-2-84-2pl.out 
## Reading model:  cfa-cam-boot-2-85-2pl.out 
## Reading model:  cfa-cam-boot-2-86-2pl.out 
## Reading model:  cfa-cam-boot-2-87-2pl.out 
## Reading model:  cfa-cam-boot-2-88-2pl.out 
## Reading model:  cfa-cam-boot-2-89-2pl.out 
## Reading model:  cfa-cam-boot-2-9-2pl.out 
## Reading model:  cfa-cam-boot-2-90-2pl.out 
## Reading model:  cfa-cam-boot-2-91-2pl.out 
## Reading model:  cfa-cam-boot-2-92-2pl.out 
## Reading model:  cfa-cam-boot-2-93-2pl.out 
## Reading model:  cfa-cam-boot-2-94-2pl.out 
## Reading model:  cfa-cam-boot-2-95-2pl.out 
## Reading model:  cfa-cam-boot-2-96-2pl.out 
## Reading model:  cfa-cam-boot-2-97-2pl.out 
## Reading model:  cfa-cam-boot-2-98-2pl.out 
## Reading model:  cfa-cam-boot-2-99-2pl.out
Summary of A parameters for the CAM
Item Full sample parameter estimate Mean SD Min p25 Median p75 Max
rcamlf1a 2.61 2.71 0.39 1.85 2.43 2.67 2.93 4.31
rcamlf2a 2.45 2.68 0.59 1.76 2.29 2.55 2.91 5.62
rcamlf3a 3.92 5.91 3.41 3.02 4.05 4.85 6.35 28.09
rcamlf4a 1.95 1.64 0.35 0.93 1.38 1.59 1.86 2.69
rcamlf5a 2.27 2.46 0.36 1.75 2.23 2.43 2.65 4.38
rcamlf6a 1.96 1.92 0.22 1.45 1.76 1.92 2.05 2.97
rcamlf7a 1.36 1.34 0.19 0.87 1.21 1.34 1.47 2.00
rcamlf8a 1.65 1.32 0.16 0.81 1.22 1.32 1.43 1.81
rcamlf8d 1.01 1.56 0.35 0.80 1.31 1.52 1.76 2.81
rcamlf9a 0.73 0.63 0.17 0.16 0.52 0.63 0.75 1.18
Summary of B parameters for the CAM
Item Full sample parameter estimate Mean SD Min p25 Median p75 Max
rcamlf1a 0.80 0.83 0.06 0.63 0.79 0.83 0.87 1.01
rcamlf2a -0.24 -0.25 0.05 -0.40 -0.28 -0.24 -0.21 -0.11
rcamlf3a 1.11 1.05 0.06 0.90 1.01 1.04 1.08 1.25
rcamlf4a 2.46 2.95 0.41 2.12 2.64 2.90 3.21 4.48
rcamlf5a 0.92 0.91 0.06 0.77 0.87 0.91 0.95 1.15
rcamlf6a 0.81 0.64 0.06 0.45 0.59 0.64 0.68 0.85
rcamlf7a 1.76 1.88 0.19 1.44 1.75 1.87 1.99 2.55
rcamlf8a 2.87 3.06 0.32 2.39 2.83 3.03 3.23 4.51
rcamlf8d 4.07 3.12 0.39 2.39 2.84 3.06 3.34 4.54
rcamlf9a 4.17 4.99 1.63 2.69 3.93 4.56 5.46 17.72

Sensitivity/Supplemental Analyses

This section contains analyses that are more exploratory in nature, and could be supplemental to the manuscript.

Information plots using only first threshold

These analyses explore the contribution the second and third thresholds have on the overall information levels of the instruments.

Figure S1: Test Information Curve using only the first threshold

Figure S2: Difference in Information curves between dichotomous and polytomous outcomes

Figure S3: Difference in measurement error between dichotomous and polytomous outcomes

Figure S4: Boxplot of standard error of measurement for dichotomous model (from Mplus)

The delirium intensity has been cut into bins of size = 0.2. Boxplots of the SEM are shown for each bin.

Figure S5: Boxplot of standard error of measurement for polytomous model (from Mplus)

The delirium intensity has been cut into bins of size = 0.2. Boxplots of the SEM are shown for each bin.

Figure S6: Standard error of measurement for dichotomous model (from Information function)

Figure S7: Standard error of measurement for polytomous model (from Information function)